American Journal of Forensic Medicine and Pathology最新文献

Abstract: Conduction system hamartoma is a benign hamartomatous lesion arising from Purkinje and Purkinje-like cells of the heart. We aimed to investigate the cases that we detected during postmortem histopathological examination. The histopathology reports of the cases autopsied between 2012 and 2022 were reviewed retrospectively. The cases were evaluated in terms of histopathological features, demographic data, autopsy findings, causes of death, microbiological results, and accompanying cardiac anomalies. There was a total of 4 cases. The female-to-male ratio was 3/1. The mean age of the cases was 5.8 months. The heart weight was found within the normal range when evaluated according to age and gender. Microscopy revealed sharply demarcated cell groups or layers with histiocyte-like cells with foamy cytoplasm. Congenital heart disease and lung infection were given as causes of death in all cases. The lesion, which was previously called histiocytoid cardiomyopathy and many different names, is known as "conduction system hamartoma" in the latest World Health Organization classification (5th edition). Being aware of this entity that causes fatal arrhythmias and sudden cardiac deaths is important for pathologists. Autopsy findings should be evaluated by taking extra samples from the heart if necessary, especially in suspected cases below 2 years of age.

Abstract: The ossa cordis (OC), or cardiac bone, is a bony structure within the cardiac skeleton of mammals, believed to maintain heart shape during systole and enhance contraction efficiency. Found in large mammals, especially ruminants, and has recently been described in chimpanzees; however, OC has not previously been described in humans. Herein, we present an incidental finding of OC in the heart of a 39-year-old man who suffered a stab wound to chest. A thorough postmortem examination revealed a 0.8 × 0.6 × 0.4-cm, well-defined, boomerang-shaped, bony structure embedded in atrioventricular node location in the right atrium within the triangle of Koch. The heart showed cardiomegaly and moderate atherosclerosis in the left anterior descending and right coronary arteries but was otherwise normal, without fibrosis, valvular abnormalities, or degenerative changes. Histological analysis revealed mature bone with trilineage hematopoietic elements. This finding highlights anatomical similarities between human hearts and other species, raising questions about whether OC in humans and primates is linked solely to degenerative cardiac disorders or represents a normal aspect of mammalian heart development and aging. To our knowledge, this is the first reported case of an OC in a human.

Abstract: There are few reports that discuss the nebulous entity known as posttraumatic subacute meningitis. Herein, we describe a case where a male was found deceased with Streptococcus pyogenes meningitis 7 days after experiencing head trauma inflicted with a tow chain. Computed tomography scan prior to death revealed a scalp laceration with subcutaneous gas and a subdural hematoma. On autopsy, the lacerations had exposed the cranial bone, but no fracture was identified. Purulence and a pinpoint defect were observed on the dura. Histologic sections of the dura and brain showed a chronic inflammatory infiltrate, ventriculitis, and vascular involvement by bacteria. Toxicology studies were positive for methamphetamine, fentanyl, and oxycodone. Post-mortem cerebrospinal fluid and blood cultures grew S. pyogenes, complementing the gram-staining of the bacteria seen in the brain sections.While the overlying parietal bone in the area of purulence was notably thinned, a direct route of infection from the soft tissue laceration to the meninges was not grossly identified. The middle ear mastoid cells did not display purulence, and the antemortem computed tomography scan did not provide any support for an otorhinolaryngeal source for the Streptococcus meningitis. To our knowledge, this is the first published report linking head trauma to S. pyogenes meningitis.

Abstract: Pedestrian and bicyclist fatalities have increased over the past decade in the United States. Factors proposed to explain this increase include the increased popularity of larger passenger vehicles, road design to accommodate faster-moving traffic, and poor road infrastructure. We analyzed a series of 102 pedestrian and bicyclist fatalities to determine which factors were involved. Results demonstrated substance abuse as the most common pertinent decedent medical history, a disproportionate number of crashes occurred during evening/nighttime hours, and most crashes involved larger passenger vehicles. The percentage of cases involving sport utility vehicles (SUVs) has increased over time. Injury pattern analysis demonstrated that smaller passenger vehicles at lower speeds were more likely to cause lower extremity fractures compared to SUVs. Alcohol was the most common decedent substance detected on toxicology, and decedents with a previous mental health history were more likely to have positive toxicology for illicit substances than those without. Sixty-three percent of cases lacked sidewalks, and 85% of cases lacked bike lanes. We compared the trends that we saw on a small scale to those seen nationally and uncovered certain novel associations from the perspective of medical examination.

Abstract: While abrasions and lacerations are typically easily identified, darker pigmentation of the skin may obscure contusions. Forensic pathology literature shows a disproportionate number of illustrations of contusions on lighter skin tones compared to darker ones. Skin and soft tissue dissection is the most reliable method to confirm contusions.The authors seek to establish a correlation between skin tone and the visual identification of contusions, confirmed by soft tissue dissection. Additionally, they aim to determine the utility of specialized dissections for identifying contusions on different skin tones to identify cases that may benefit from such procedures.A review of cases from the Cook County Medical Examiner's Office from 2014 to 2024 was conducted. The office database was searched for deaths in custody, causes including "assault," and "child abuse." Autopsy photos were compiled into predissection and postdissection sets, reviewed for skin tone, visual identification of contusions, and final confirmation of soft tissue hemorrhage.Results found a negative association between skin color and accurate visual identification of contusions and determined that decedents with a skin tone of 7 or higher on the Massey-Martin scale may benefit from specialized dissections.

Abstract: Wischnewsky spots are disseminated, dark lesions in gastric mucosa reflecting hemorrhage associated with fatal hypothermia, and are a phenomenon well known to forensic pathologists. We applied luminol and leucomalachite green tests to formalin-fixed gastric mucosa with Wischnewsky spots in autopsy cases of hypothermia. Both luminol and leucomalachite green tests showed positive reactions. We describe the technical significance of these tests in forensic diagnosis, in that luminol and leucomalachite green tests may be useful in forensic autopsy cases, and may also be useful for formalin-fixed organs.

Abstract: Necrotizing wound infections are potentially lethal complications of surgeries, including cesarean deliveries. A 32-year-old female with obesity and hidradenitis suppurativa (HS) underwent uncomplicated cesarean section. Four days later, she developed abdominal pain and imaging showed ascites; she was treated with antibiotics. She progressed to septic shock and expired the following day from cardiopulmonary arrest. Hospital blood cultures grew no microorganisms. Autopsy revealed soft tissue purulence around the incision and copious purulent ascites without evidence of tubo-ovarian abscess, retained products of conception, or emboli. Microscopic examination of the tissues demonstrated inflammatory debris with neutrophils and gram-positive cocciform bacteria. Postmortem bacterial cultures had no growth. Paraffin blocks submitted to the Centers for Disease Control Infectious Disease Pathology Branch revealed Streptococcus pyogenes. Historically, group A streptococcus (GAS) was a major cause of peripartum mortality, and the prevalence of puerperal sepsis-associated deaths declined with antibiotic usage. Although the rates of mortality have remained stable in the United States, GAS has made a resurgence over recent decades. Additionally, there is some evidence in the literature of cutaneous bacterial biofilms associated with HS. Theoretically, this could have increased the risk of perioperative infection due to colonization or secondary infection of HS lesions.

Abstract: Forensic investigation of intrauterine and perinatal deaths can be challenging, given their relative infrequency and the possible involvement of maternal substance use, trauma, and socioeconomic factors. Intrauterine and perinatal deaths investigated by the Cuyahoga County Medical Examiner's Officer between 2013-2023 were reviewed. One hundred twenty-eight cases were identified (83 stillborn and 45 live births). The predominant indications for referral were concern for maternal substance use (57.8%) or trauma (35.2%). Gestational ages ranged from 11.5 to 42.5 weeks; 36.7% were <22 weeks, and only 10.2% were full term (>37 weeks). The maternal age range was 16-41 years, with most (65.2%) between 20-34 years. Not all case files included obstetric history or home address; of those which did, 53.0% received no prenatal care and 81.7% came from zip codes in the bottom quartile of household incomes. Causes of death included acute and/or chronic maternal substance use (28.9%), chorioamnionitis (21.9%), and abruption (19.5%). Manners of death (when applicable) included natural (53.3%), accident (26.7%), homicide (8.9%), and undetermined/unassigned (11.1%). Potentially confounding socioeconomic factors were identified in most cases. This demonstrates the importance of considering these factors and exercising caution when assigning specific causes and manners to intrauterine and perinatal deaths.